TY - JOUR
KW - Adaptation, Psychological
KW - Adolescent
KW - Adult
KW - Child
KW - Child Health Services
KW - Child Welfare
KW - Child, Preschool
KW - Cyclonic Storms
KW - Disaster Planning/organization & administration
KW - Family Health
KW - Health Services Accessibility
KW - Health Services Needs and Demand
KW - Humans
KW - Infant
KW - Infant, Newborn
KW - Louisiana
KW - Medically Underserved Area
KW - Mental Disorders
KW - Mental Health
KW - Program Development
KW - Relief Work
KW - Stress Disorders, Post-Traumatic/prevention & control
KW - Time Factors
KW - United States
AU - P. A. Madrid
AU - H. Sinclair
AU - A. Q. Bankston
AU - S. Overholt
AU - A. Brito
AU - R. Domnitz
AU - R. Grant
A1 - 
AB - INTRODUCTION: Hurricane Katrina, a Category 3 hurricane, made landfall in August 2005. Approximately 1,500 deaths have been directly attributed to the hurricane, primarily in Louisiana and Mississippi. In New Orleans, Louisiana, most of the healthcare infrastructure was destroyed by flooding, and > 200,000 residents became homeless. Many of these internally displaced persons received transitional housing in trailer parks ("villages") under the auspices of the [US] Federal Emergency Management Agency (FEMA). PROBLEM: The FEMA villages are isolated from residential communities, lack access to healthcare services, and have become unsafe environments. The trailers that house families have been found to be contaminated with formaldehyde. METHODS: The Children's Health Fund, in partnership with the Mailman School of Public Health at Columbia University, began a program ("Operation Assist") to provide health and mental health services within a medical home model. This program includes the Baton Rouge Children's Health Project (BRCHP), which consists of two mobile medical units (one medical and one mental health). Licensed professionals at the FEMA villages and other isolated communities provide care on these mobile units. Medical and psychiatric diagnoses from the BRCHP are summarized and case vignettes presented. RESULTS: Immediately after the hurricane, prescription medications were difficult to obtain. Complaints of headache, nosebleeds, and stomachache were observed at an unusually frequent degree for young children, and were potentially attributable to formaldehyde exposure. Dermatological conditions included eczema, impetigo, methicillin-resistant staphylococcus aureus (MRSA) abscesses, and tinea corporis and capitis. These were especially difficult to treat because of unhygienic conditions in the trailers and ongoing formaldehyde exposure. Signs of pediatric under-nutrition included anemia, failure to thrive, and obesity. Utilization of initial mental health services was low due to pressing survival needs and concern about stigma. Once the mental health service became trusted in the community, frequent diagnoses for school-age children included disruptive behavior disorders and learning problems, with underlying depression, anxiety, and stress disorders. Mood and anxiety disorders and substance abuse were prevalent among the adolescents and adults, including parents. CONCLUSIONS: There is a critical and long-term need for medical and mental health services among affected populations following a disaster due to natural hazards. Most patients required both medical and mental health care, which underscores the value of co-locating these services.
BT - Prehospital and disaster medicine : the official journal of the National Association of EMS Physicians and the World Association for Emergency and Disaster Medicine in association with the Acute Care Foundation
C5 - Medical Home
CP - 4
CY - United States
IS - 4
JF - Prehospital and disaster medicine : the official journal of the National Association of EMS Physicians and the World Association for Emergency and Disaster Medicine in association with the Acute Care Foundation
N2 - INTRODUCTION: Hurricane Katrina, a Category 3 hurricane, made landfall in August 2005. Approximately 1,500 deaths have been directly attributed to the hurricane, primarily in Louisiana and Mississippi. In New Orleans, Louisiana, most of the healthcare infrastructure was destroyed by flooding, and > 200,000 residents became homeless. Many of these internally displaced persons received transitional housing in trailer parks ("villages") under the auspices of the [US] Federal Emergency Management Agency (FEMA). PROBLEM: The FEMA villages are isolated from residential communities, lack access to healthcare services, and have become unsafe environments. The trailers that house families have been found to be contaminated with formaldehyde. METHODS: The Children's Health Fund, in partnership with the Mailman School of Public Health at Columbia University, began a program ("Operation Assist") to provide health and mental health services within a medical home model. This program includes the Baton Rouge Children's Health Project (BRCHP), which consists of two mobile medical units (one medical and one mental health). Licensed professionals at the FEMA villages and other isolated communities provide care on these mobile units. Medical and psychiatric diagnoses from the BRCHP are summarized and case vignettes presented. RESULTS: Immediately after the hurricane, prescription medications were difficult to obtain. Complaints of headache, nosebleeds, and stomachache were observed at an unusually frequent degree for young children, and were potentially attributable to formaldehyde exposure. Dermatological conditions included eczema, impetigo, methicillin-resistant staphylococcus aureus (MRSA) abscesses, and tinea corporis and capitis. These were especially difficult to treat because of unhygienic conditions in the trailers and ongoing formaldehyde exposure. Signs of pediatric under-nutrition included anemia, failure to thrive, and obesity. Utilization of initial mental health services was low due to pressing survival needs and concern about stigma. Once the mental health service became trusted in the community, frequent diagnoses for school-age children included disruptive behavior disorders and learning problems, with underlying depression, anxiety, and stress disorders. Mood and anxiety disorders and substance abuse were prevalent among the adolescents and adults, including parents. CONCLUSIONS: There is a critical and long-term need for medical and mental health services among affected populations following a disaster due to natural hazards. Most patients required both medical and mental health care, which underscores the value of co-locating these services.
PP - United States
PY - 2008
SN - 1049-023X; 1049-023X
SP - 314
EP - 321
EP - 
T1 - Building integrated mental health and medical programs for vulnerable populations post-disaster: Connecting children and families to a medical home
T2 - Prehospital and disaster medicine : the official journal of the National Association of EMS Physicians and the World Association for Emergency and Disaster Medicine in association with the Acute Care Foundation
TI - Building integrated mental health and medical programs for vulnerable populations post-disaster: Connecting children and families to a medical home
U1 - Medical Home
U2 - 18935945
VL - 23
VO - 1049-023X; 1049-023X
Y1 - 2008
ER -